25th Congress of the European Society for Pediatric Neurosurgery (ESPN) Paris-France, 8-11 May 2016
Child's Nervous System
Objective: To describe gait of children with lipoma in a clinical setting. Children with lipomyelomeningocele (spinal lipoma) have a spectrum of physical presentations affecting neurological and urological function, musculoskeletal deformity, pain and motor deficits (Kanev et al., 1990; Kulwin et al, 2013; Segal et al, 2013). Evidence to support prophylactic untethering is conflicting. Current practice at GOSH is to monitor within an MDT clinic and intervene promptly if function deteriorates.
... entifying deterioration is challenging as baseline function and tethering presentations vary. Standard mobility classification is often insensitive to symptom progression.This study explores identification of subtle walking deficits in this population, and monitoring progress or progression of symptoms. Material and Methods: 26 children who attended dysraphic clinic at GOSH between Jan 2013-June 2014 completed a GAITRite assessment as part of routine follow up. Children walked across a 6 m pressure sensitive carpet 3 times at preferred, slow and fast speeds. 2 children were assessed at multiple time intervals. Approval for retrospective review was granted by GOSH/ICH Research and Development Office. Results: Mean age was 8.6 years (range 3.8-17.9). Preferred velocity mean (sd) was 116.2 cm/s (21.0); fast velocity 172.0 cm/s (37.3). Data was plotted on normal gait centiles, from 650 typically developing children, and converted to Z scores using LMS-Growth. Preferred walking velocity fell within the 25th and 75th centiles with no significant difference between Z scores and predicted age means (p >0.05). Velocity, cadence (p <0.01), single support and double support (p =0.02) were all significantly different for the lipoma group at fast speeds. Conclusion: Velocity of children with lipoma falls within normal ranges at preferred speed. Progressive symptoms are associated with reduced endurance, falling behind peers, with slowing of gait when walking fast. Longitudinal gait measurement in children with Lipoma at fast and preferred speeds may identify subtle deteriorations, aiding surgical decision making. OP02 Spinal lipoma of the filum terminale: review of 174 consecutive patients Purpose: Spinal lipoma of the filum terminale (LFT) is a congenital lumbosacral anomaly that can cause tethered cord syndrome. Purposes of this study are to clarify preoperative characteristics of LFT, to elucidate surgical effects, and to discuss the reasonability of prophylactic surgery for LFT. Methods: One hundred and seventy four children (2008)(2009)(2010)(2011)(2012)(2013)(2014) who underwent section of LFT were prospectively followed for prevalence of symptoms, skin stigmas, and associated malformations, motivator of diagnosis, conus level, and surgical outcome. Mean age at surgery was 4.1±4.2 years old (37 days to 17.7 years). Results: Ninety-four children (54.0%) had skin stigmas and 60 (34.5%) had certain perineal malformations. Seventy-nine children (45.4%) were symptomatic. The most common motivator for diagnosis was skin stigmas (44.3%), followed by syndromes (33.3%), and symptoms (20.1%). The age at surgery was significantly older in symptomatic patients than in Childs Nerv Syst (2016) 32:905-1012